March 15, 2022; 98 (11) Research Article
Lack of Association of Group A Streptococcal Infections and Onset of Tics
European Multicenter Tics in Children Study
Anette-Eleonore Schrag, Davide Martino, Hanyuying Wang, Gareth Ambler, Noa Benaroya-Milstein, Maura Buttiglione, Francesco Cardona, Roberta Creti, Androulla Efstratiou, Tammy Hedderly, Isobel Heyman, View ORCID ProfileChaim Huyser, View ORCID ProfilePablo Mir, Astrid Morer, Natalie Moll, View ORCID ProfileNorbert E. Müller, Kirsten R. Müller-Vahl, Kerstin J. Plessen, Cesare Porcelli, Renata Rizzo, Veit Roessner, Markus Schwarz, Zsanett Tarnok, View ORCID ProfileSusanne Walitza, Andrea Dietrich, Pieter J. Hoekstra, on behalf of European Multicentre Tics in Children Study (EMTICS)
First published February 2, 2022, DOI: https://doi.org/10.1212/WNL.0000000000013298
Anette-Eleonore Schrag
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Davide Martino
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Hanyuying Wang
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Gareth Ambler
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Noa Benaroya-Milstein
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Maura Buttiglione
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Francesco Cardona
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Roberta Creti
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Androulla Efstratiou
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Tammy Hedderly
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Isobel Heyman
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Chaim Huyser
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Pablo Mir
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Astrid Morer
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Natalie Moll
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Norbert E. Müller
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Kirsten R. Müller-Vahl
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Kerstin J. Plessen
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Cesare Porcelli
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Renata Rizzo
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Veit Roessner
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Markus Schwarz
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Zsanett Tarnok
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Susanne Walitza
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Andrea Dietrich
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Pieter J. Hoekstra
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
From the Department of Clinical Neuroscience (A.E.S., H.W.), UCL Institute of Neurology, and Department of and Statistical Science (G.A.), University College London, UK; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Child and Adolescent Psychiatry Department (N.B.-M.), Schneider Children's Medical Centre of Israel, Petah-Tikva, Affiliated to Sackler Faculty of Medicine, Tel Aviv University; Department of Biomedical Sciences and Human Oncology (M.B.), University of Bari “Aldo Moro”; Department of Human Neurosciences (F.C.), University La Sapienza of Rome; Department of Infectious Diseases (R.C.), Istituto Superiore di Sanità, Rome, Italy; WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections (A.E.), Reference Microbiology Division, National Infection Service, Public Health England; Evelina London Children's Hospital GSTT (T.H.), Kings Health Partners AHSC; Psychological Medicine (I.H.), Great Ormond Street Hospital NHS Foundation Trust, London, UK; Levvel (C.H.), Academic Center for Child and Adolescent Psychiatry; Amsterdam UMC (C.H.), Department of Child and Adolescent Psychiatry, the Netherlands; Unidad de Trastornos del Movimiento (P.M.), Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.M.), Madrid; Department of Child and Adolescent Psychiatry and Psychology (A.M.), Institute of Neurosciences, Hospital Clinic Universitari; Institut d'Investigacions Biomediques August Pi i Sunyer (A.M.), Barcelona; Centro de Investigacion en Red de Salud Mental (A.M.), Instituto Carlos III, Madrid, Spain; Institute of Laboratory Medicine (N.M., M.J.S.) and Department of Psychiatry and Psychotherapy (N.E.M.), University Hospital, LMU Munich; Department of Psychiatry, Social Psychiatry and Psychotherapy (K.R.M.-V.), Hannover Medical School, Germany; Child and Adolescent Mental Health Centre (K.v.P.), Mental Health Services, Capital Region of Denmark and University of Copenhagen; Division of Child and Adolescent Psychiatry (K.v.P.), Department of Psychiatry, Lausanne University Hospital, Switzerland; ASL BA (C.P.), Mental Health Department, Adolescence and Childhood Neuropsychiatry Unit, Bari; Child and Adolescent Neurology and Psychiatry (R.R.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of Child and Adolescent Psychiatry (V.R.), Medical Faculty Carl Gustav Carus, TU Dresden, Germany; Vadaskert Child and Adolescent Psychiatric Hospital (Z.T.), Budapest, Hungary; Department of Child and Adolescent Psychiatry and Psychotherapy (S.W.), University of Zurich, Switzerland; and University of Groningen (A.D., P.J.H.), University Medical Centre Groningen, Department of Child and Adolescent Psychiatry, the Netherlands.
Lack of Association of Group A Streptococcal Infections and Onset of Tics
European Multicenter Tics in Children Study
Anette-Eleonore Schrag, Davide Martino, Hanyuying Wang, Gareth Ambler, Noa Benaroya-Milstein, Maura Buttiglione, Francesco Cardona, Roberta Creti, Androulla Efstratiou, Tammy Hedderly, Isobel Heyman, Chaim Huyser, Pablo Mir, Astrid Morer, Natalie Moll, Norbert E. Müller, Kirsten R. Müller-Vahl, Kerstin J. Plessen, Cesare Porcelli, Renata Rizzo, Veit Roessner, Markus Schwarz, Zsanett Tarnok, Susanne Walitza, Andrea Dietrich, Pieter J. Hoekstra, on behalf of European Multicentre Tics in Children Study (EMTICS)
Neurology Mar 2022, 98 (11) e1175-e1183; DOI: 10.1212/WNL.0000000000013298
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Abstract
Background and Objectives The goal of this work was to investigate the association between group A streptococcal (GAS) infections and tic incidence among unaffected children with a family history of chronic tic disorders (CTDs).
Methods In a prospective cohort study, children with no history for tics who were 3 to 10 years of age with a first-degree relative with a CTD were recruited from the European Multicentre Tics in Children Study (EMTICS) across 16 European centers. Presence of GAS infection was assessed with throat swabs, serum anti–streptolysin O titers, and anti-DNAse titers blinded to clinical status. GAS exposure was defined with 4 different definitions based on these parameters. Cox regression analyses with time-varying GAS exposure were conducted to examine the association of onset of tics and GAS exposure during follow-up. Sensitivity analyses were conducted with Cox regression and logistic regression analyses.
Results A total of 259 children were recruited; 1 child was found to have tic onset before study entry and therefore was excluded. Sixty-one children (23.6%) developed tics over an average follow-up period of 1 (SD 0.7) year. There was a strong association of sex and onset of tics, with girls having an ≈60% lower risk of developing tics compared to boys (hazard ratio [HR] 0.4, 95% confidence interval [CI] 0.2–0.7). However, there was no statistical evidence to suggest an association of any of the 4 GAS exposure definitions with tic onset (GAS exposure definition 1: HR 0.310, 95% CI 0.037–2.590; definition 2: HR 0.561, 95% CI 0.219–1.436; definition 3: HR 0.853, 95% CI 0.466–1.561; definition 4: HR 0.725, 95% CI 0.384–1.370).
Discussion These results do not suggest an association between GAS exposure and development of tics.
Classification of Evidence This study provides Class I evidence that group A streptococcal exposure does not associate with the development of tics in children with first-degree relatives with chronic tic disorder.
Glossary
- ADB=
- anti–DNAse B;
- ASOT=
- anti–streptolysin O titer;
- CTD=
- chronic tic disorder;
- DSM-IV-TR=
- Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision;
- EMTICS=
- European Multicentre Tics in Children Studies;
- GAS=
- group A streptococcal;
- TS=
- Tourette syndrome
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
European Multicentre Tics in Children Study (EMTICS) coinvestigators are listed at links.lww.com/WNL/B751.
Infographic: links.lww.com/WNL/B858
Class of Evidence: NPub.org/coe
CME Course: NPub.org/cmelist
- Received April 1, 2021.
- Accepted in final form December 21, 2021.
- © 2022 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence
- Author Response: Lack of Association of Group A Streptococcal Infections and Onset of Tics
- Anette Schrag, Physician, University College London
Submitted April 28, 2022 - Reader Response: Lack of Association of Group A Streptococcal Infections and Onset of Tics
- Rajat Gupta, Consultant Paediatric Neurologist, Birmingham Children's Hospital, Birmingham, UK
- Dritan Agalliu, Associate Professor, Departments of Neurology, Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, USA
- Alberto Spalice, Professor and Paediatric Neurology, Department of Maternal Sciences, Paediatric Neurology, Sapienza University of Rome, Italy
- Herbert M Lachman, Professor of Medicine (Hematology), Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine. Bronx, New York, U.S.A.
- Tim Ubhi, Consultant Paediatrician, The Children’s e-Hospital, United Kingdom & Consultant Paediatrician, County Durham & Darlington NHS Foundation Trust, UK
- Kiki Chang, Adjunct Professor of Psychiatry, McGovern Medical School University of Texas Health Science Center at Houston, Palo Alto, CA, USA
- Jennifer Frankovich, Clinical Professor of Pediatric Rheumatology, Stanford Children’s Hospital, Stanford University, Palo Alto, CA, USA
- Anders Fasth, Professor of Pediatric Immunology, Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden
- Mats Johnson, Associate Professor of Child and Adolescent Psychiatry, Gillbergcentrum/Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Elisabeth Fernell, Professor of Child and Adolescent Psychiatry, Gillbergcentrum/Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Ida Walles, Consultant Child and Adolescent Psychiatrist,, Uppsala University Hospital, Uppsala, Sweden
- Susanne Bejerot, Professor of Psychiatry, School of Medical Sciences, Örebro University, Örebro University, Örebro, Sweden
- Peter J van der Spek, Professor of Clinical Bioinformatics, Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, Netherlands
- Janet L Cunningham, Associate Professor of Psychiatry, Department. of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
Submitted April 10, 2022
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